Young Athlete’s Neck Pain After Tennis Signals Rare Stroke Risk

A 25-year-old man in Hyderabad felt a sharp sting in his neck during a lively tennis match. Thinking it was just a muscle tweak, he visited a local clinic and was treated with painkillers. The soreness eased temporarily, but the next day, he developed dizziness, unsteady gait, and imbalance. Alarmed, he consulted Dr. Sudhir Kumar, a neurologist at Apollo Hospitals, trained at CMC Vellore.

From the sequence of neck pain followed by neurological symptoms, Dr. Kumar suspected a vascular cause. MRI and angiography confirmed a vertebral artery dissection that had led to a small ischemic stroke in the brain’s posterior circulation.

Understanding Vertebral Artery Dissection

The vertebral arteries pass through the vertebrae of the neck, carrying blood to the brainstem and cerebellum. Each artery has three layers -- intima (inner), media (middle), and adventitia (outer). When the inner lining tears, blood can pool within the vessel wall or create a flap that obstructs flow, sometimes forming clots, as per Cleveland Clinic.

Cervical artery dissections are a leading cause of stroke in adults under 45. Triggers include sudden or forceful neck movements during sports, yoga, or even minor trauma like coughing. In severe cases, clots can obstruct blood flow and cause an ischemic stroke, or the artery can rupture, leading to a hemorrhagic stroke.

A similar case was published by MedizinOnline, where a 37-year-old physiotherapist developed a vertebral artery dissection and cerebellar infarction after being struck by a tennis ball. He was successfully treated with antithrombotic therapy and rehabilitation, with vessel recanalization confirmed on follow-up imaging.

Recognizing Critical Symptoms

The Hyderabad athlete’s symptoms included neck pain followed by dizziness, imbalance, and unsteadiness which are classic warning signs. Other red flags include double or blurred vision, severe headache, vertigo, slurred speech, ataxia, or sudden hearing loss.

Dr. Kumar stresses that while most neck pain is harmless, its combination with neurological symptoms should prompt urgent evaluation.

Management and Recovery

The patient was admitted for close neurological monitoring. Early physiotherapy focused on restoring balance and safe mobility. Within weeks, his symptoms improved, and he returned to normal life — with advice to avoid abrupt or extreme neck manipulations.

Standard treatment often involves antithrombotic therapy such as antiplatelet or anticoagulant drugs to prevent further clot formation. In the MedizinOnline case, a dual regimen of low molecular weight heparin and antiplatelet therapy was later tapered to a single agent, with good outcome.

Key Takeaways

For the Public

• Not all neck pain is “just a strain.” If it’s followed by dizziness, imbalance, vision changes, or weakness, seek urgent care.

• Avoid high-risk neck manipulations during sports or chiropractic adjustments.

• Strokes can happen in the young; prompt recognition and treatment save lives.

For Doctors & General Practitioners

• Consider vertebral artery dissection when acute neck pain is followed by posterior circulation symptoms.

• Early MRI/MRA is critical to confirm diagnosis.

• Timely initiation of antithrombotic therapy can prevent disabling or fatal strokes.

As Dr. Sudhir Kumar emphasizes, awareness among both doctors and the public can mean the difference between full recovery and lifelong disability.

(Rh/Eth/VK)